CiCi's Local Application   
Personal information:
  Last Name: * First Name: * Middle Initial:
Social Security #: Are You 16 Years or Older: Yes No
 
Street Address: * Apt #:    
City: * State: * Zip: *
Area Code: * Telephone #: * - *
Position Applying For:

MASON RD. HOME

Schedule Available to Work:  
Full Time: Day Evening All Schedules Summer   
Part Time: Day Evening After School
How Were You Referred to CiCi's:    
Advertisement College Recruiting Agency Career Fair
Referral Name:
Walk-In
Names of Friends or Relatives Employed by CiCi's Pizza:
General Information:   
Have You Ever Applied to CiCi's Pizza: Yes No
If Yes, Date and Location:
Have You Ever Worked for CiCi's Pizza: Yes No
If Yes, Date and Location:
To Comply with Federal Law, Will You Be Able to Establish Your Right to Work in the US if Offered a Job?: Yes No
Have You Ever Been Fired? : Yes No

If Yes, Explain:

Have You Ever Been Convicted of a Felony within the Past 10 Years?: Yes No
If Yes, Explain:
Are You Able to Perform the Essential Functions of the Job for which You are Applying?: Yes No
Do You Now Have Hepatitus A, Salmonella Typhl, or any other illness, which can be spread by serving or preparing food?: Yes No  
If Yes, Explain:
School Most Recently Attended:   
Name: Location: Course of Study:
Now Enrolled? : Yes No Highest Grade Completed :    
Employment History:
List all jobs and activities, which indicate your qualifications including military service, schools, part time employment, self-employment and periods of unemployment for the past 5 years. Please also list significant experience more than 5 years ago. Begin with most recent.
May We Contact Your Current Employer? : Yes No

Company One:

Company Name: Telephone #: -

Address: Employed: (Month/Year) From: To:

Name of Supervisor: Annual Salary Base Rate: Start: Final:

Reason For Leaving:

                      

Company Two:

Company Name: Telephone #: -

Address: Employed: (Month/Year) From: To:

Name of Supervisor: Annual Salary Base Rate: Start: Final:

Reason For Leaving:

                      

Company Three:

Company Name: Telephone #: -

Address: Employed: (Month/Year) From: To:

Name of Supervisor: Annual Salary Base Rate: Start: Final:

Reason For Leaving:

                      

Company Four:

Company Name: Telephone #: -

Address: Employed: (Month/Year) From: To:

Name of Supervisor: Annual Salary Base Rate: Start: Final:

Reason For Leaving:

                      
I certify that the information provided in this application by me is correct to the best of my knowledge and understand that deliberate falsification of this information is grounds for denial of employment or immediate dismissal. I authorize the references listed above and any others provided to you, to give you any and all information concerning my previous employment and any peretinent information to you. I understand that nothing contained in this employment application or in the granting of an interview creates an employment contract between CiCi's Pizza and my self for either employment or for the providing of any benefit. If any employment relations is established, I understand that I have the right to terminate my employment at any time and CiCi's Pizza retains the same right.
Date:   Name: *

It is Company policy to only hire individuals authorized to work in the US

CiCi' Pizza is an equal opportunity employer and it complies with all discimination laws. Information requested on this application will not be used for any purpose prohibited by law .